PONE-D-24-35321Clinical Profile Of Alcohol Dependent Paintents According To Lesch Typology One Year After The Covid-19 Pandemic-Comparative StudyPLOS ONE

Dear Dr. Kuljancic,

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PLOS ONE

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Additional Editor Comments:

Please address Reviewer 1s comments. Once these comments are addressed, the publication will be further considered for publication. 

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: First, I’d like to commend the authors on producing a well-organized and timely manuscript. The study presents an important investigation into the clinical profiles of alcohol-dependent patients one year post-COVID-19, based on the Lesch Typology. The data-driven rejection of the hypothesis regarding an increase in Type II and III alcohol dependence is particularly valuable, and I believe this study makes a meaningful contribution to our understanding of how the pandemic has affected alcohol use patterns.

That being said, I’d like to offer a few suggestions for improvement, which I believe could strengthen the paper even further.

1. Expanding on the Increase in Type I Dependence:

While the manuscript does touch on the observed rise in Type I dependence, I think this aspect of the findings deserves more attention. The increase could be tied to the disruptions in healthcare services during the pandemic, which may have left some individuals unable to receive timely care for their somatic conditions. As a result, alcohol might have been used as a coping mechanism. Delving into how these healthcare challenges could have contributed to this rise would add valuable context to the findings.

Suggestion: It might be worth adding a section to the discussion focused on “Pandemic Healthcare Disruptions and the Rise of Type I Dependence.” By exploring how restricted access to healthcare during the pandemic may have influenced the patterns of alcohol dependence, the manuscript could offer a deeper understanding of this shift. This would also tie in nicely with the broader implications of how external stressors, like healthcare availability, can impact addiction patterns.

2. Clarifying the Impact of Vaccination on Hospitalization Outcomes:

The manuscript highlights the positive effects of COVID-19 vaccination on hospitalization outcomes, which is a key finding. However, I feel that the methodology for how this effect was measured could be explained in more detail. Were specific health markers or hospitalization duration compared between vaccinated and non-vaccinated patients? Were there control variables to account for differences in health status or severity of alcohol dependence?

Suggestion: Providing more details about the statistical methods used to assess the impact of vaccination would really help clarify these findings. For example, how were hospitalization outcomes specifically measured in vaccinated versus non-vaccinated patients? This could strengthen the conclusions around vaccination’s benefits and support stronger recommendations for its role in managing vulnerable populations like alcohol-dependent individuals.

3. Addressing Limitations and Future Research:

I appreciate that the manuscript acknowledges some limitations, but I believe expanding on this could further enhance the paper. For instance, the retrospective nature of the study poses certain challenges, and this could be discussed in more depth. Additionally, proposing future research directions—such as longitudinal studies or multi-center collaborations—would offer a proactive way to build on this study’s findings.

Suggestion: Including a more detailed "Limitations and Future Directions" section would be beneficial. By suggesting prospective studies that track alcohol dependence patterns over time, or studies that investigate these trends across different regions, the authors could provide a roadmap for future research. This would not only address the limitations but also showcase how this study sets the stage for ongoing inquiry in the field.

Conclusion:

I believe this is a well-executed and valuable study that addresses an important issue. By expanding on the rise in Type I dependence, clarifying the methodology behind the vaccination findings, and providing more insight into the study's limitations and future directions, the manuscript could be further strengthened. I genuinely look forward to seeing how these revisions will enhance the final version of the paper.

Thank you again for the opportunity to review this insightful and relevant work.

Reviewer #2: While this article effectively demonstrates the psychosocial aspects of addiction to psychoactive substances, specifically alcohol, it also provides a comprehensive analysis of the various factors involved in alcohol abuse. The well-written article effectively delves into the psychological and social elements contributing to alcohol addiction. However, it should be noted that the article does have limitations, including potential selection bias, lack of generalizability, and some degree of sample bias. Despite these flaws, the article still offers valuable insights into the complexities of alcohol abuse.

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Reviewer #1: No

Reviewer #2: Yes:  Rajasekhar Kannali

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PONE-D-24-35321R1Clinical Profile Of Alcohol Dependent Paintents According To Lesch Typology One Year After The Covid-19 Pandemic-Comparative StudyPLOS ONE

Dear Dr. Kuljancic,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Feb 24 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Souparno Mitra, M.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Please address the reviewers comments in order to consider for acceptance. 

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: I Don't Know

Reviewer #4: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: In the introduction -Please go into more detail regarding the exact proposed definition of each type. so that the readers have a thorough understanding of each type.

Please avoid using terms such as "Alcoholic" and "Alcoholism" - Instead use "Alcohol Use disorder".

See the remaining revierw comments in the attached PDF.

Reviewer #4: The previous suggestions have been incorporated. I have a couple more recommendations for a minor revision before being accepted.

1. The hypothesis regarding an increase in type II and III alcohol dependence was not supported by the data, yet the study does not explore alternative explanations sufficiently. Delve deeper into sociocultural and systemic factors that may explain the stability in type II and III dependency, such as support networks or societal resilience.

2. Provide more information about the software used for Lesch typology, including validation and reliability metrics.

3. Conduct thorough proofreading and use professional editing services to improve clarity and readability.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #3: Yes:  Arun Prasad

Reviewer #4: Yes:  Nikhil Tondehal

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Completed.pdf

Clinical Profile Of Alcohol Dependent Paintents According To Lesch Typology One Year After The Covid-19 Pandemic-Comparative Study

PONE-D-24-35321R2

Dear Dr. Kuljancic,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Souparno Mitra, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: This study examined issues related to substance abuse and addiction in the post-pandemic context. The study design is appropriate; however, it did not confirm the anticipated increase in alcohol consumption driven by anxiety. Instead, it highlighted how pandemic-related stress has affected drinking patterns. The sample size is small, which limits generalizability and makes it difficult to account for confounding factors. Additionally, the strain on the healthcare system and limited access to medical services have influenced trends in alcohol dependence. Future research is essential to assess the long-term psychological effects of the pandemic on alcohol use.

Reviewer #3: Thanks for the edits to the article. Hopefully we'll have more data in the future on the same which will strengthen the study.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: No

Reviewer #3: Yes:  Arun Prasad

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